Provider Demographics
NPI:1518476068
Name:GUARDIAN CONVENIENT CLINIC
Entity Type:Organization
Organization Name:GUARDIAN CONVENIENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-478-0404
Mailing Address - Street 1:10300 W CHARLESTON BLVD STE 13-416
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1037
Mailing Address - Country:US
Mailing Address - Phone:702-478-0404
Mailing Address - Fax:
Practice Address - Street 1:11850 TEVARE LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6501
Practice Address - Country:US
Practice Address - Phone:702-478-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care